Senior Executive Manager PR Management📣 إعلان

About the Role

Bupa Arabia is seeking a Senior Executive Manager PR Management to lead effective contract management and network design for providers. This contract-based role, located in Jeddah and Makkah, focuses on implementing agreed provider strategies and frameworks while ensuring compliance with CCHI & SAMA rules and regulations. The manager will drive effective price and cost management, achieve project savings, and align with sales and marketing to develop new products and services that support business development, market proposition, profitability, and expansion goals.

Contract and Pricing Management

• Establish contract rules and standards with all providers to serve business interests.
• Oversee and engage in contracting new providers, new service codes, and contract renewals.
• Ensure contracts comply with regulatory, renewal, and licensing requirements.
• Revamp the coding system, including introducing unified parent codes and eliminating redundancy.
• Implement business obligations for ICD 10-AM systems.
• Resolve issues related to invalid/duplicate service codes and overbilling.
• Develop standard discount structures, PPD rules, and volume discount slabs.

Provider Network Optimization and Cost Effectiveness

• Introduce systems for comprehensive benchmarks for frequently billed items (regional and per network).
• Develop processes and guidelines for unbenchmarked items to ensure fair pricing.
• Create pricing models, guidelines, and benchmarks for optical and other unique services.
• Develop and negotiate price reduction plans to achieve business goals.
• Enhance plans for service bundling (in & out patients) and expansion of surgical packages with providers.
• Ensure new and renewed contract prices align with benchmarks and business targets.
• Provide regular price forecasting to business stakeholders.
• Ensure a comprehensive provider network covering all benefits for each class.
• Regularly enhance the provider network (down/upgrading) based on risk cost and business requirements.
• Optimize accessible, affordable, optical, and dental provider networks.
• Manage pharmacy benefits, including networking, formularies, and refill systems.
• Enhance stepladder referrals system with regular updates for best practice and cost effectiveness.
• Develop a network of anchor providers and centers of excellence.
• Manage volume re-allocation of services between providers as needed.

Service Innovation and Strategic Partnerships

• Explore and develop new payment approaches like paradigm shifts, prepaid services, and accountable care organizations.
• Explore and develop partnership relations with strategic providers.
• Develop providers, physicians, and service finder tools for website support.
• Introduce healthcare plans that respond to market needs, health & benefits, and business developments.
• Develop new products and services, such as Fast track, external doctors, special arrangements (SPA), high-skill physicians network, maternity, and uncovered services.

Stakeholder Coordination and Team Leadership

• Communicate contract additions/deletions, amendments, and significant milestones to operation and technical teams.
• Provide regular price forecasts to commercial finance.
• Communicate network redesigns and referral system updates to operation and sales teams.
• Coordinate with sales, marketing, and commercial finance on volume re-allocation, healthcare plans, and network updates.
• Provide leadership, professional guidance, and direction to assigned team members.
• Prepare and oversee Key Performance Indicators (KPIs) for the team.
• Facilitate goal setting, manage, and review individual performance.
• Provide regular feedback, coaching, and development.
• Motivate and empower direct reports by providing technical expertise, tools, and support.
• Build the capabilities of team members.

Required Qualifications

• A minimum of 5-10 years of relevant experience in contract management, provider network design, or a similar field within the insurance or healthcare sector.
• Demonstrated understanding of CCHI & SAMA rules and regulations.
• Proven ability to manage complex contracts and negotiate effectively.
• Experience in developing pricing models, benchmarks, and cost-effectiveness plans.
• Strong leadership and people management skills, with experience in guiding and developing teams.
• Excellent communication and coordination abilities for internal and external stakeholders.